Although there have been studies of clients' perceptions of health visiting, the views of single, unsupported mothers about the health visiting service have been under-researched. Therefore, this study investigated their views using semi-structured interviews with 12 single, unsupported mothers identified by health visitors within one National Health Service Community Trust. The data were analysed using Burnard's (1991) thematic content analysis, which enabled a number of identifiable themes to emerge. Findings showed that the participants perceived the health visiting service as being concerned almost exclusively with babies and there was a general lack of understanding about the broader role of the health visitor. Clinics were seen as places to visit to weigh the baby but not as a contact point with a health visitor. Some health visitors were perceived as being judgemental in attitude and not necessarily interested in the clients as individuals. Participants considered that health visitors should be friendly, interested, able to promote their confidence and offer individualized advice. Overall the study suggests that health visitors may not be utilizing all dimensions of their role with single, unsupported mothers and may not be communicating effectively with them about this. The study also shows that single, unsupported mothers wish to be treated in the same way as other mothers but at present some feel that they are stigmatized and treated differently. The paper concludes with an outline of the implications of the findings and recommendations for practice and future research.

We have implemented an 'evidence-based referral' for primary care patients in dermatology, cardiology and peripheral vascular disease. Telemedicine clinics bring together a district nurse, patient and vascular surgeon to discuss diagnosis, management and care. During a 30-month study, a total of 30 patients participated in telemedicine clinics. The mean consultation time fell from 23 to 10 min. In parallel, the type of consultation changed from dermatology to vascular surgery. Nineteen patients participated in vascular telemedicine clinics over the last 16 months of the study. The average consultation time was 10 min (SD 1), which included discussion of the case and negotiation of its management. The average consultation time in the equivalent outpatient clinic in the same hospital for the same consultant was 15 min. The acquisition of the relevant information in primary care could lead to a reduction of 75% in outpatient clinic appointments.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

We report a rare case of spontaneous spinal epidural hematoma. Various presentations may occur, most commonly including neck pain, interscapular pain, radicular pain, and paralysis. This condition is frequently associated with paralysis and long‐term disability. This case is unique because it presented with right hand cyanosis, in addition to pain. A 69‐year‐old Caucasian female presented with cyanosis of the right hand, and severe right upper extremity pain which awakened her approximately 11 hours earlier. The pain was exacerbated on extending her head. The patient further reported bilateral shoulder pain and interscapular pain. She reported no motor weakness or paralysis. She denied any history of trauma. The patient was taking aspirin 81 mg/d for the past 2 months. Physical examination revealed cyanosis of the digits of the right hand as well as mildly diminished right biceps reflex and right grip strength. No edema or rashes were noted. Skin was warm and dry. Pulses were +2 in all extremities. Vital signs were within normal limits. The remainder of the physical examination was unremarkable. Magnetic resonance imaging of the cervical/thoracic spine revealed a right posterior–lateral epidural hematoma extending from the 3rd cervical level to the 1st thoracic level of the spinal cord. There was also evidence of cord compression at the 4th‐5th and 5th‐6th cervical levels. Given the potential for significant complications, clinicians should maintain a high index of suspicion for spinal epidural hematoma, particularly in those patients taking anticoagulation. Symptoms, including extremity cyanosis, pain, and paralysis all are suggestive of the diagnosis.